Provider Demographics
NPI:1477790616
Name:BURT, ASHLEY E (RDH)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:BURT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-981-1721
Mailing Address - Fax:724-981-7025
Practice Address - Street 1:350 SHARON NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121
Practice Address - Country:US
Practice Address - Phone:724-981-1721
Practice Address - Fax:724-704-7418
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH069365124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034997450001Medicaid
PA1034997450002Medicaid